Real-World Treatment Patterns for Acute Lymphoblastic Leukemia Utilizing Claims Data

OBJECTIVES: Treatment options for acute lymphoblastic leukemia (ALL) have changed over the years and include bispecific T-cell engager (BiTE), and chimeric-antigen receptor (CAR) T-cell therapies. Using a large United States (US) claims database, this study assessed real-world treatment patterns of ALL patients in the past few years.

METHODS: ALL patients with one inpatient or two outpatient ALL diagnosis codes (ICD-10: C910x; ICD-9: 2040, 20400, 20401, 20402) were identified within the database between September 1, 2017, through December 31, 2022. Patients with procedure codes and pharmacy claims related to ALL treatments were included. Date of first record of ALL diagnosis was defined as the index date. Patients were followed up until end of continuous enrollment or end of the study period. First line of therapy (LoT) was defined as the date of the earliest prescription or administration for ALL treatment on or after the index date. For subsequent LoTs, start date was defined as the date of the earliest treatment on or after the end of the prior LoT (60 days after).

RESULTS: A total of 39,239 ALL patients were identified with approximately half aged 18 years or older (49%). Most patients were male (58%), and the median length of follow-up was 29 months (interquartile range (IQR): 38 months). The median number of LoT identified was 2 (IQR:2). Common therapeutic agents used for the first LoT and the second LoT were vincristine sulphate (51%, 28%), dexamethasone (34%, 26%), mercaptopurine (40%, 24%), prednisone (29%, 20%), and methotrexate (25% and 17%), respectively. Blinatumomab, inotuzumab ozogamicin and tisagenlecleucel were administered either solely or in combination with the above chemotherapeutic agents.

CONCLUSIONS: Established chemotherapeutic agents are widely used as initial therapies for ALL patients. Real-world claims data from the US show an increasing use of therapies that have been approved in the past decade, in conjunction with established agents.